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PLEASE PRINT; <br />OFFICE USE ONLYDate2/12/2016 <br />APPLICATION FOR ENCROACHMENT PERMIT <br />2"1"''','2uOnPiK-Ph 1:50 <br />OEP',.(,"r'-l,J,".-"Ut;je Il,!(),'.:-K S <br />To:San Joaquin County <br />Department of Public Works <br />PG&E <br />(Applicant Name) <br />4040 WEST LN <br />(Mailing Address) <br />STOCKTON,CA 95204 <br />(City,State,Zip Code) <br />408-316-1767 <br />(Area Code -Telephone Number) <br />JOB# <br />APN <br />EXP.DATE <br />VALID' <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />730os-~-~REF# <br />CR# <br />DRIVEWAYS: <br />Sketch (Detailed plans may besubmitted) <br />SEE ATTACHED SKETCH <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-ol-Way on <br />the SO'ith side of W Fllclid Ave approximately 385'leeilmile East <br />of Wisconsin Ave Stn"ktnn,by performing the following work (description 01work): <br />Digging up 4'X4'of asphalt for a service replacement to 3301 W Euclid Ave <br />PM 31218076 <br />days.60 <br />~fL//b <br />,I Date <br />for approximately <br />ature 01Applicant -Title <br />I,the undersigned,c ,fythat I am owner of the respective property,or am qualified to represent the owner and agree to do the <br />nce with the rules and regulationsof San Joaquin County and subject to inspection and approval. <br />I <br />rI•••:\-{lJ,i <br />E:\PUB-SV.WliIMI\STERPSlENCROACHMENf PERMITAPPlICATION,DOC (OlIOS)